Evaluating Virtual-Reality Training for Effective Pneumothorax Management in Thoracentesis

Abstract

Complication management remains one of the most underemphasized aspects of procedural training in med-ical education. Thoracentesis, though commonly performed, carries the risk of iatrogenic tension pneu-mothorax, a rare but life-threatening complication that requires rapid recognition and decisive management. Traditional training approaches often focus on procedural recall and step-by-step technical execution, leaving gaps in preparing learners to respond effectively under real-world pressures. This thesis presents the design and evaluation of a virtual reality (VR)-based training module that simulates a thoracentesis scenario leading to iatrogenic tension pneumothorax. The module was co-designed with clinical educators, integrating compli-cation triggers, to evaluate learners’ clinical decision-making. A mixed-methods study with medical residents was conducted, combining quantitative measures (knowledge quizzes, usability, immersion, presence, work-load questionnaires) with qualitative findings (simulation performance, semi-structured interviews). Results demonstrate that VR-based complication training can strengthen learners’ perceived procedural awareness, conditional reasoning, and adaptive problem-solving beyond procedural recall. Learners reported high en-gagement and perceived realism, while also identifying areas for improvement, such as complication realism, feedback clarity, and role-based design considerations. The contributions of this thesis are: (i) process flow design blueprint for VR training and assessment, (ii) empirical evidence of learning impact of complication management in VR, (iii) perceived usability, user experience, and realism insights, and (iv) design principles for complication-focused VR training.